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.
Friday, April 15, 2016
Friday, April 8, 2016
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:
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.
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.
Mary is still working on using emotions to decrease her depression. This week, humor is the subject. Humor is a multi-part process:
- 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.”
- 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.
- 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.
- 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.
- 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.
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.
Friday, April 1, 2016
Using Feelings-Thought Connections with Caregiver Depression
Mary is back this week. She's George's caregiver. Mary, like most dementia caregivers, has periods of depression. No surprise! This was not what she had looked forward to in her Golden Years. Instead of the Caribbean cruise she and George had planned, she's cleaning the bathroom floor. Instead of playing cards with friends, she's watching TV alone while George sleeps restlessly in the next room. Instead of the intimate lunches she and George used to enjoy, she's dealing with George's delusions of her supposed infidelity. And so on. Day by day, she watches the person who was once her major support disappear further into his Lewy fog.
Past blogs have discussed the way George can't change the way he responds to his feelings. Mary can. Mary can choose to make changes in her daily life that will decrease her depression. In the 9/25/14 blog, exercise, socialization, being positive and medication were suggested. Today's blog focuses on the connections between emotions and thinking, and how Mary can use these to decrease her situational depression. (See the 9/25/14 blog for the difference between situational and chronic depression.)
Negative emotions are motivators. However, when they become overpowering, they may, like too much stress, be immobilizing. It's sort of like PD rigidity, where the brain demands that the body move faster than it can move. With Mary's depression, she is experiencing more uncomfortable negative stimuli than she can deal with, and so her feeling center shuts down. Mary's negative aren't so stressful anymore, but sadly, she also doesn't experience those warm, fuzzy happy feelings either.
In the past Mary buried her unwelcome feelings, thinking, "Why should I give them space in my life? I'll just not think about this and it will all go away." But they don't go away. Mary's buried feelings simmer like a pot of soup on the back burner of the stove. Then they boil over when Mary's stress is so high that she isn't able to keep them in tamped down, causing even more stress. But there are some things that Mary can do.
Past blogs have discussed the way George can't change the way he responds to his feelings. Mary can. Mary can choose to make changes in her daily life that will decrease her depression. In the 9/25/14 blog, exercise, socialization, being positive and medication were suggested. Today's blog focuses on the connections between emotions and thinking, and how Mary can use these to decrease her situational depression. (See the 9/25/14 blog for the difference between situational and chronic depression.)
Negative emotions are motivators. However, when they become overpowering, they may, like too much stress, be immobilizing. It's sort of like PD rigidity, where the brain demands that the body move faster than it can move. With Mary's depression, she is experiencing more uncomfortable negative stimuli than she can deal with, and so her feeling center shuts down. Mary's negative aren't so stressful anymore, but sadly, she also doesn't experience those warm, fuzzy happy feelings either.
In the past Mary buried her unwelcome feelings, thinking, "Why should I give them space in my life? I'll just not think about this and it will all go away." But they don't go away. Mary's buried feelings simmer like a pot of soup on the back burner of the stove. Then they boil over when Mary's stress is so high that she isn't able to keep them in tamped down, causing even more stress. But there are some things that Mary can do.
- Talking about those negative feelings reduces their power. When Mary gives names to her negative feelings, the action moves from her brain's feeling areas to its thinking areas--and her view of the event becomes more objective than personal, and therefore, less painful. Mary needs to put her feelings into words, even if she does it by talking to herself. (Mary should NOT do this with George; he will take her feelings personally, expand on them, and make them worse for both him and Mary.)
- Talking about positive feelings increases their power. It causes the brain to secrete serotonin, a chemical that increases happiness. One might think that since talking about negative feelings reduces their power, it would do the same with positive feelings. But this isn't the case. Sharing them with George will cause his brain to secrete serotonin and he'll feel happier too! And of course, Mary should not limit her sharing to just George. Like yawning and measles, happiness is contagious. But unlike those, it is a great thing to catch!
- Writing about difficult stuff makes it easier to handle and writing about good good stuff makes you happier. Like many caregivers, Mary keeps a daily diary where she documents all the things she may need to show to a doctor or family member later. It is also a good place for Mary to vent--and to share her successes and other positives. This is another way for her to get those negative feelings into words and decrease their power. Writing about the positive experiences will cause Mary's brain to secrete serotonin just as it did during the event itself. Reading it later will too!
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.
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.
Saturday, March 26, 2016
Accepting Delusions
Today, think of a time when you had an immediate reaction to something. Let's say, you saw your spouse laughing with someone on the phone. Did you have any niggling feelings of being left out? That's normal. But before you acted on those feelings, you used your reasoning ability to tested them and found them lacking. Then, you let them go and got on with your life.
Let me re-introduce George, a stand in for your loved one with LBD. Just substitute your loved one's name for his as you read along. George's LBD is far enough along that his ability to think is damaged. He sees his spouse, Mary, on the phone and he has the same feelings you had of being left out. But he can't use his reasoning ability to dismiss those uncomfortable feelings--and they build. Then his brain makes up a story to make sense of these terrible feelings. And now he KNOWS that Mary is laughing with a lover and planning to leave him.
A few weeks ago, we did an exercise where you imagined where you lived and I tried to convince you that you didn't live there. George's belief in his brain's drama is as firm and solid as yours is about where you live. You will no more be able to convince him that it isn't real than I was able to convince you that you didn't live where you live.
George's ability to control his impulses is also damaged. And so what he feels, he acts upon. He immediately accuses Mary of laughing with her lover and planning to leave him. He doesn't wait until after she hangs up and ask for answers that might change his mind. He KNOWS the answers already. His brain has supplied them. And he CAN'T change his mind. To do so would be to deny his very sanity.
Quick review of emotions from last week: Emotions add impact to an event and the more intense the emotion, the better we remember. Negative emotions are more intense because their function is to initiate action--to cause us to move away from or change whatever is uncomfortable.
And so, back to George. His reasoning ability is damaged, but his memory is fairly intact. Unlike someone with Alzheimer's, he can remember names, and events. He may get them confused, but he remembers. And he especially remembers situations where there are strong negative emotions. The more negative feelings around an event, the more likely he is to remember it--and the longer he will remember it.
And so how do you think George feels when Mary denies his accusations? Tells him she'd never think of doing anything like that. Maybe even cries. Remember, George believes with all his mind that he is right. Does he feel unheard? Lied to? Frustrated? Frightened? Does Mary's denials increase or decrease his negative feelings? How long do you think he will remember this? Will he obsess over it? Bring it up again and again? Get angrier and angrier with each denial?
So now, if you are Mary, how can you deal with such rigidity? How do you defuse George's negative feelings? First, as long as those feelings are present, George can't change. But YOU can. You can change from trying to convince him to accept your reality to accepting his reality. You don't have to believe it, but you do have to accept it. It's that simple...and that difficult. You have to let them know that you hear them. Last week, we did that by repeating what George said about his hallucinations. However, when the person with LBD is accusing you, there's another way that works even better.
Just say "I'm sorry." This is very simple...and for many, very, very difficult. But give it a try. You don't have to admit you did it, but you must apologize. This defuses the situation and decreases the emotional load.
With each round of sorrys, George's negative feelings will decrease. Then you can move one.
Start deep breathing. You don't have to say anything. Just deep breath. It's contageous! Soon he'll be deep breathing too.
And finally, once you are both calmer, try some distraction. Ice cream is always a good choice!
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 information about better communication, view Teepa Snow's videos:
Teepa Snow's Positive Approach to Dementia Care
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.
Let me re-introduce George, a stand in for your loved one with LBD. Just substitute your loved one's name for his as you read along. George's LBD is far enough along that his ability to think is damaged. He sees his spouse, Mary, on the phone and he has the same feelings you had of being left out. But he can't use his reasoning ability to dismiss those uncomfortable feelings--and they build. Then his brain makes up a story to make sense of these terrible feelings. And now he KNOWS that Mary is laughing with a lover and planning to leave him.
A few weeks ago, we did an exercise where you imagined where you lived and I tried to convince you that you didn't live there. George's belief in his brain's drama is as firm and solid as yours is about where you live. You will no more be able to convince him that it isn't real than I was able to convince you that you didn't live where you live.
George's ability to control his impulses is also damaged. And so what he feels, he acts upon. He immediately accuses Mary of laughing with her lover and planning to leave him. He doesn't wait until after she hangs up and ask for answers that might change his mind. He KNOWS the answers already. His brain has supplied them. And he CAN'T change his mind. To do so would be to deny his very sanity.
Quick review of emotions from last week: Emotions add impact to an event and the more intense the emotion, the better we remember. Negative emotions are more intense because their function is to initiate action--to cause us to move away from or change whatever is uncomfortable.
And so, back to George. His reasoning ability is damaged, but his memory is fairly intact. Unlike someone with Alzheimer's, he can remember names, and events. He may get them confused, but he remembers. And he especially remembers situations where there are strong negative emotions. The more negative feelings around an event, the more likely he is to remember it--and the longer he will remember it.
And so how do you think George feels when Mary denies his accusations? Tells him she'd never think of doing anything like that. Maybe even cries. Remember, George believes with all his mind that he is right. Does he feel unheard? Lied to? Frustrated? Frightened? Does Mary's denials increase or decrease his negative feelings? How long do you think he will remember this? Will he obsess over it? Bring it up again and again? Get angrier and angrier with each denial?
So now, if you are Mary, how can you deal with such rigidity? How do you defuse George's negative feelings? First, as long as those feelings are present, George can't change. But YOU can. You can change from trying to convince him to accept your reality to accepting his reality. You don't have to believe it, but you do have to accept it. It's that simple...and that difficult. You have to let them know that you hear them. Last week, we did that by repeating what George said about his hallucinations. However, when the person with LBD is accusing you, there's another way that works even better.
Just say "I'm sorry." This is very simple...and for many, very, very difficult. But give it a try. You don't have to admit you did it, but you must apologize. This defuses the situation and decreases the emotional load.
- I'm sorry I made you feel that way. (Be careful not to say "I'm sorry you...." This just puts it back on your loved one.)
- I'm sorry, I won't do it again.
- I'm sorry. That must feel awful. Speak to the feelings.
- I'm sorry. This is hard for both of us.
With each round of sorrys, George's negative feelings will decrease. Then you can move one.
Start deep breathing. You don't have to say anything. Just deep breath. It's contageous! Soon he'll be deep breathing too.
And finally, once you are both calmer, try some distraction. Ice cream is always a good choice!
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 information about better communication, view Teepa Snow's videos:
Teepa Snow's Positive Approach to Dementia Care
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.
Friday, March 18, 2016
Accepting Hallucinations
Last week the blog was about how caregivers can reduce stress by accepting their loved one's reality and allowing them to feel heard. This is no small thing. This week, we expand on this. Please go back and read the last two week's blogs if you haven't already. It's important that you understand how fully a person with LBD (PwLBD) is locked into their own reality.
This week, George is still here. He is a stand in for your loved one with LBD. As you read this, use your loved one's name instead of his. George "sees" things. Things you can't see, but he can and he knows beyond a doubt they are real. Mostly, he sees "little people." Others with LBD see dogs, children, or even bugs. You call these "hallucinations" but George doesn't that. It implies that what he sees isn't real. Call them "little people" like he does. Then he knows you accept his reality and that's important to him. Actually, he isn't that much different from any of us that way. We all like to know that the people we care about accept who we are and what we say.
When George's little people first showed up, he was still able to reason well enough that he could test for reality. He understood that when he saw the little people but no one else did, then the little people weren't real. It's been over three years now however, and Lewy bodies have damaged his ability to reason and he can't do that anymore. Now he accepts the initial information as fact. The little people he "sees" are as real to him as the chair you are sitting on is to you.
Some PwLBD, especially those who've had traumatic experiences, will see scary things, but mostly what is seen is benign. They might be fascinating, fun or, like George's little people, just friendly companions. Some people hear sounds like telephones, but they don't hear voices like a person with schizophrenia does. George's little people don't upset him, but when you try to convince him that they aren't real, then that does.
Actually, George's "seeing" is more likely to upset you than him. Your distress is evidence of denial, an early step in the grieving process. Denial leads you to try to get you to accept your reality. When you get it that he can't, they you advance to sadness. It is normal for you to grieve as you see George's unwelcome changes. But it is not helpful to do it in front of him. He will mirror your distress and his symptoms will increase. Instead, step back, even leave the room if you must. Then when you can, return and give him the support he needs. This does not mean you shouldn't grieve. Just do it later, when he's not around.
You don't have to pretend to "see" what he does, but you do have to accept that his little people are very real to him. If you don't; if you try to convince him of your reality, he'll respond by feeling a lot of negative emotions like frustration and anger--intense emotions that make the situation even worse. The more upset he feels, the more stressed he becomes, the more irrational will be.
George can't change. He KNOWS his little people are real. You can change. You can accept his reality. (See last week's blog about how to do this.) When you do, he will calm down. As he does, the negative feelings will decrease. The sooner you can accept George's little people, the less impact there will be.
You can change but it takes time. At first, you will find yourselves arguing about whose reality is right. This normal. Don't beat yourself up over it. Just step back, and take a deep breath. Then start over. Take some more deep breaths. It's calming and the extra oxygen improves cognition...for both of you! Always remember to breathe out twice as long as you breathe in to prevent hyperventilation. You don't need to say anything. Just start breathing. It's contagious! George will soon start be breathing right along with you. Then you can go back to being supportive.
Some helpful hints about dealing with hallucinations:
Next week, the blog will be about some revolutionary ways to accept delusions.
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 information about better communication, view Teepa Snow's videos:
Teepa Snow's Positive Approach to Dementia Care
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.
This week, George is still here. He is a stand in for your loved one with LBD. As you read this, use your loved one's name instead of his. George "sees" things. Things you can't see, but he can and he knows beyond a doubt they are real. Mostly, he sees "little people." Others with LBD see dogs, children, or even bugs. You call these "hallucinations" but George doesn't that. It implies that what he sees isn't real. Call them "little people" like he does. Then he knows you accept his reality and that's important to him. Actually, he isn't that much different from any of us that way. We all like to know that the people we care about accept who we are and what we say.
When George's little people first showed up, he was still able to reason well enough that he could test for reality. He understood that when he saw the little people but no one else did, then the little people weren't real. It's been over three years now however, and Lewy bodies have damaged his ability to reason and he can't do that anymore. Now he accepts the initial information as fact. The little people he "sees" are as real to him as the chair you are sitting on is to you.
Some PwLBD, especially those who've had traumatic experiences, will see scary things, but mostly what is seen is benign. They might be fascinating, fun or, like George's little people, just friendly companions. Some people hear sounds like telephones, but they don't hear voices like a person with schizophrenia does. George's little people don't upset him, but when you try to convince him that they aren't real, then that does.
Actually, George's "seeing" is more likely to upset you than him. Your distress is evidence of denial, an early step in the grieving process. Denial leads you to try to get you to accept your reality. When you get it that he can't, they you advance to sadness. It is normal for you to grieve as you see George's unwelcome changes. But it is not helpful to do it in front of him. He will mirror your distress and his symptoms will increase. Instead, step back, even leave the room if you must. Then when you can, return and give him the support he needs. This does not mean you shouldn't grieve. Just do it later, when he's not around.
You don't have to pretend to "see" what he does, but you do have to accept that his little people are very real to him. If you don't; if you try to convince him of your reality, he'll respond by feeling a lot of negative emotions like frustration and anger--intense emotions that make the situation even worse. The more upset he feels, the more stressed he becomes, the more irrational will be.
George can't change. He KNOWS his little people are real. You can change. You can accept his reality. (See last week's blog about how to do this.) When you do, he will calm down. As he does, the negative feelings will decrease. The sooner you can accept George's little people, the less impact there will be.
You can change but it takes time. At first, you will find yourselves arguing about whose reality is right. This normal. Don't beat yourself up over it. Just step back, and take a deep breath. Then start over. Take some more deep breaths. It's calming and the extra oxygen improves cognition...for both of you! Always remember to breathe out twice as long as you breathe in to prevent hyperventilation. You don't need to say anything. Just start breathing. It's contagious! George will soon start be breathing right along with you. Then you can go back to being supportive.
Some helpful hints about dealing with hallucinations:
- Ask George if his little people are bothering him. If he says they aren't, then you can ignore them. When Annie "saw" a woman on the couch, Jim asked, found out Annie wasn't bothered, and said "OK, we'll just let her sit there." and Annie was fine with that. Let yourself be fine with it too.
- Ask George to tell you about them. Ask questions. What kind of clothes are they wearing? What color...? This will often make them disappear...his brain can't deal with so many specifics.
- If they are bothering him, join his reality and you can probably get rid of the hallucinations. Jim used to usher Annie's "visiting" children out of the house, saying, "OK, kids, time to go home now." Once the door was closed, so was her hallucination.
- Accept George's little people as a fact of life, a part of the family. The more relaxed you are around then, the less problem they will be to either one of you.
Next week, the blog will be about some revolutionary ways to accept delusions.
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 information about better communication, view Teepa Snow's videos:
Teepa Snow's Positive Approach to Dementia Care
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.
Saturday, March 12, 2016
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.
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.
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.
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.
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.
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:
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.
Friday, March 4, 2016
When a Loved One Has Dementia
Great news to folks in the Phoenix-Mesa, Arizona, area. We have two events coming up that you won't want to miss. We are very invested in helping caregivers find ways to deal with LBD and other dementias with fewer drugs. LBD caregivers especially know how important that is. And you also know how difficult it can seem with all the behavior issues that Lewy can bring out in our loved ones. Our goal with these classes is to offer you ways to do deal with these issues that you might not have considered.
The first is a two hour class called "When a Loved One Has Dementia." We will be talking about dementia in general and LBD specifically, focusing on ways to relate that cause less stress to both caregiver and loved one. You'll even get to practice some of the suggestions. No need to register for this class. Just show up ready to learn!
That class will give you a small taste of what our second event, Alternative Therapies for Dementia Care, will be like. This one is an all day event, with five sessions,. Ours will be the first session, but four very talented people will follow with hands-on sessions about different types of alternative therapies and how to use them with people who have dementia or other neurological disorders. We've already advertised this workshop once, but the date has been changed. It will now be held on April 30th. If you go to HealingThings.com and register before March 15th the cost for the whole day, tools for each session (including one of our books!), breakfast, lunch and snacks is only $155.
As a family caregiver, you may think that an all day event like this is too long to be away from your loved one. However, taking time for yourself can be very therapeutic for both of you so it is worth considering. Such a fun-filled day will send you back home feeling revived and better able to do your job.
If your loved one is attending adult daycare or living in a care facility, this is also an excellent workshop for professional caregivers. Pleases share this information with the facility staff and suggest that someone attend. They won't be sorry they went! We know the other presenters.They are all excellent in their field and all are invested in teaching ways to use these therapies to increase quality of life for the person with dementia while decreasing the workload for staff...or family caregivers.
Here's the new flier:
The first is a two hour class called "When a Loved One Has Dementia." We will be talking about dementia in general and LBD specifically, focusing on ways to relate that cause less stress to both caregiver and loved one. You'll even get to practice some of the suggestions. No need to register for this class. Just show up ready to learn!
- Date and time: Sunday, March 13th, from 1:30pm to 3:30pm
- Location: Unity of Mesa Church, 2700 E. Southern Ave, Mesa, AZ.
- Cost: A $15 donation is suggested, but no one will be turned away.
That class will give you a small taste of what our second event, Alternative Therapies for Dementia Care, will be like. This one is an all day event, with five sessions,. Ours will be the first session, but four very talented people will follow with hands-on sessions about different types of alternative therapies and how to use them with people who have dementia or other neurological disorders. We've already advertised this workshop once, but the date has been changed. It will now be held on April 30th. If you go to HealingThings.com and register before March 15th the cost for the whole day, tools for each session (including one of our books!), breakfast, lunch and snacks is only $155.
As a family caregiver, you may think that an all day event like this is too long to be away from your loved one. However, taking time for yourself can be very therapeutic for both of you so it is worth considering. Such a fun-filled day will send you back home feeling revived and better able to do your job.
If your loved one is attending adult daycare or living in a care facility, this is also an excellent workshop for professional caregivers. Pleases share this information with the facility staff and suggest that someone attend. They won't be sorry they went! We know the other presenters.They are all excellent in their field and all are invested in teaching ways to use these therapies to increase quality of life for the person with dementia while decreasing the workload for staff...or family caregivers.
Here's the new flier:
Click here to go to HealingThings.com for more information and to register.
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