- For people living with dementia the ability to relax may become compromised due to high levels of anxiety.
- Regular hypnotherapy can have a positive impact on concentration, relaxation, motivation, activities of daily living, immediate memory, memory for significant events, and socialisation.
- Self-relaxation techniques are a good way of helping to combat anxiety, stress, agitation and frustration, which are often present with people living with dementia.
Don’t we all enjoy the opportunity to slip off our shoes and simply kick back for some ‘me’ time? We know how much better we feel after we have had that time to simply relax – to withdraw into our own world where we can be at one with our thoughts.
For people living with dementia, and those supporting that journey, the ability to relax may become compromised due to high levels of anxiety, one of the Behavioral and Psychological Signs and Symptoms of Dementia (BPSD). There are ways of helping to reduce anxiety without resorting to medication as a first-line treatment, and this article aims to teach you ways in which this can be done.
In 2003, I led an empirical clinical research project in Liverpool, testing whether hypnotherapy could be of benefit to people living in (a) a nursing home and (b) a residential home. Both services were for people who had various types of dementia. Our findings were so amazing that our research was published in peer-reviewed journals in both Europe and the US. So, what exactly were those positive outcomes?
First, it is important to note that we had an active group who received one hour of hypnotherapy each week for nine months, a control group who attended a weekly discussion group for nine months and a treatment-as-usual group who received nothing different from their usual care for nine months. Those involved in the project were a cross-section of people needing nursing care and those needing only residential care. The journals are referenced below, but Figure 1 demonstrates the outcomes we found in overall quality of life.
We discovered improvements in seven key areas:
- activities of daily living
- immediate memory
- memory for significant events and socialisation.
Even more interesting was what we found during a longitudinal study carried out 12 months after therapy. When you look at Figure 1, you see these long-term results. There are two possible reasons for these outcomes. The first is that when a person is trying so hard to remember a particular thing, word, person or event, anxiety levels build and everything becomes worse. Negative thoughts, ideas and images develop, confusion increases and the process of dementia speeds up. By taking the person away from that negative thinking and into a deep state of relaxation, the hypnotherapist is able to free up the negativity and replace it with positive suggestions directed at the subconscious. As a result, we see an improvement in cognition and a more relaxed individual, who worries less.
The second possible reason is more physiological. The neurochemical acetylcholine is deficient in people with Alzheimer’s disease. This chemical is released in large quantities during REM (rapid eye movement) sleep. We know that people living with dementia have difficulty with sleeping and very rarely achieve REM. When a person enters the hypnogogic stage of hypnosis (this is when the person is going into hypnosis) it is the same as REM. This presents us with the question ‘Does the brain get a massive hit of acetylcholine at the hypnogogic phase?’ The hypnogogic state is the transitional state between wakefulness and sleep. These hypotheses have yet to be further investigated.
Case study from clinical practice
Maria was 76 years old when she was referred to me by her GP. She had been resident in a nursing home for nine months. Her anxiety levels had increased to such a degree that her quality of life, and that of her family, was rapidly declining. Her anxiety was based around the fear that her son, Alan, was going to be killed in a car accident. There was no family history of anyone being killed in this way, which meant she had underlying fears of other sorts that were being manifested in this way. Alan worked as a surgeon at the hospital, which was a 20-minute drive away. Every evening he would call in to see his mum for an hour, but his visit was so full of anxiety and negativity that he was ready to stop visiting her. Over a period of four weeks, I worked with Maria to change those negative thoughts to positive ones. In hypnosis, I spoke with her subconscious mind and made suggestions that focused on Maria preparing a tea tray, baking a cake or making biscuits and getting herself ready for a visit from her son. Maria has recently celebrated her 77th birthday and her relationship with Alan is once again a happy one.
Positive use of cognitive resources
People living with dementia (and this may also be the case with relatives supporting them along the journey) can sometimes find it difficult to free up their cognitive resources to focus on a positive experience. For example, Helen might spend a great deal of time worrying about the fact she cannot remember certain things. This leads to negative thoughts and ultimately increased levels of both internal stress and anxiety, which may be expressed through agitation, frustration and sometimes unintended aggression. So, how can these cognitive resources be freed up so that thoughts become more positive? How can these unsafe levels of stress and anxiety be reduced?
As a trained clinical hypno-psychotherapist, I suggest that one of the easiest ways in which this challenge can be managed is through self-relaxation techniques.
Relaxation and ‘me time’ is good for all of us. However, for people living with dementia, it can have that little extra, therapeutic benefit. The accompanying Toolkit document ‘Checklist – Hypnotherapy in dementia care’ is to assist non-trained hypno-psychotherapists in helping people to reach a state of therapeutic relaxation. You can find a qualified therapist at Dementia Doctor in the UK.
- Duff S C & Nightingale D J, The efficacy of hypnosis in changing the quality of life in patients with dementia. A pilot-study evaluation, Journal of Clinical Hypnosis, 6 (2), 20–29, 2005
- Duff S C & Nightingale D J, Long Term Outcomes of Hypnosis in Changing the Quality of life in Patients with Dementia, European Journal of Clinical Hypnosis, 7 (1), 2–8, 2006
- Duff S C & Nightingale D J, Alternative approaches to supporting people with dementia: Enhancing quality of life through hypnosis, Alzheimer’s Care Today, 8 (4), 321 – 331, 2007
- Hypnotherapists: http://dementiadoctor.co.uk/dts-members/
Use the following item in the Toolkit to put the ideas in the article into practice:
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