Talking therapies

4. How can talking therapies help 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. 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. 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

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.

Psychotherapy

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.