How talking therapies help someone with dementia and their carer
Talking therapies offer someone living with dementia the opportunity to speak openly about their feelings, and can help them to adjust to and live with their condition more successfully. This will help their family and carers in many ways.
What are the benefits of talking therapies for someone with dementia?
People living with dementia may also experience anxiety and depression. This may have developed before the dementia or may be caused by adjusting to the diagnosis and its effect on their lives. There is evidence that talking therapies can directly reduce symptoms of anxiety and depression in people with dementia.
Psychological approaches are particularly appropriate for people with dementia because they focus on the individual and their viewpoint.
Talking therapies are by nature structured, collaborative and focused on achieving goals and solving problems. Many people also prefer treatments that are not based on medication. This is important because the evidence suggests that antidepressant drugs do not work very well for people with dementia.
Counselling has been shown to be a way for people living with dementia to gain support and make sense of living with the condition. Many people living with dementia struggle to make sense of their diagnosis and how their life is changing. They may feel lost, confused, vulnerable or anxious. Anxiety over what the future might hold is particularly common.
Research suggests that counselling can play a particularly important role in helping people with an early diagnosis of dementia - for example, by reducing feelings of depression. Even before diagnosis, just going through assessment for suspected dementia can be confusing and stressful, and may cause feelings of anxiety. It is best practice for someone to be offered pre-diagnostic counselling to support them through this difficult and uncertain time.
There is growing evidence that psychotherapy can also help someone living with dementia.
Recent trials, for example, show that CBT and interpersonal therapy can reduce symptoms of depression and anxiety in people with dementia. This is important because in the past it was unclear whether talking therapies worked in older people or those with dementia.
Anxiety and depression are distressing in their own right but they can also affect a person's memory and thinking. Maintaining mental wellbeing can therefore ensure these abilities are not made worse for a person living with dementia.
Talking therapies such as CBT for depression or anxiety are best suited to someone who is in the mild (early) or moderate (middle) stage of dementia. At this stage people have fewer difficulties holding things in their memory, communicating and reasoning. They are also usually more aware of their condition and of their own thoughts and emotions. This means they can still engage with the therapy.
The therapy may need to be adapted to help a person with dementia to benefit. This may mean shorter sessions, use of memory aids (eg cue cards) and more reinforcement and sumarising. If the person living with dementia agrees, a family member or close friend may attend sessions. This supporter can also help the person outside of sessions to put agreed CBT strategies into place.
What are the benefits of talking therapies for families and carers of a person with dementia?
Caring for a family member or close friend with dementia is often stressful. While some carers report positive feelings of fulfilment from helping the person, many experience feelings of loss, sadness, grief, guilt or anger. Carers of people with dementia also experience high levels of anxiety and depression. Talking therapies for carers can help in all of these areas.
Talking therapies may help family and carers to explore their feelings in confidence, as well as providing extra support outside their network of friends and family. This can be especially important at times when decisions are being made about how to look after a person with dementia.
Counselling can help carers to be more aware of how their own behaviours towards the person with dementia will affect how that person feels and acts, both positively and negatively. If the carer is stressed and becomes short-tempered with the person, they are more likely to develop feelings of anxiety, depression or problematic behaviours as a result.
For carers who are depressed, telephone counselling has been shown to be an effective option. Counselling over the phone may fit in with a person's caring responsibilities more conveniently than face-to-face sessions.
Dementia affects relationships between partners greatly and some people benefit from relationship counselling or couple therapy for depression. This can be with either partner separately or both together, but the focus is on improving difficulties within the relationship.
There is good evidence that psychotherapies reduce distress in carers of people with dementia. This evidence is strongest for face-to-face or telephone CBT targeted at carers with depression and tailored to the individual and their circumstances. Carers who learn more about dementia, depression, anxiety and changes in behaviours - for example, through a structured group programme - also generally experience less distress and are better equipped to cope with their situation.
Former carers or care workers may benefit from talking therapies as well. They may feel lost or sad when the person they have cared for moves away from them or dies. After the caring relationship ends, it may be difficult to move on, to recover from the loss and to accept a new and different role. Talking therapies may help a former carer to accept the past and look ahead to the future. Some talking therapies, such as bereavement counselling or bereavement CBT, are specifically aimed at helping people come to terms with the loss of someone close to them.