Does CBT actually work

[robertjohnmills]

After several years of harassing and pleading to Mental Health services for some help, they have suggested Mark and I work at his behavioural issues using Cognitive Behavioural Therapy (CBT).
I was somewhat sceptical, but the Neuropsychologist assures me that it can be very effective in modifying difficult behaviours, even in Dementia. She has explained that it will be hard because the initial response will be WORSE behaviour before it gets better!
Has anyone tried this before or are we a unique experiment in this?
I will post our progress on this thread.

 

[Grannie G]

Dear Robert

I think anything is worth trying, to modify challenging behaviour, although knowing it might make it worse before it gets better would make me apprehensive.

Whatever you decide I wish you luck and if you do decide to go ahead I would be very interested in the outcome.

Take care xx

 

[Skye]

That's an interesting one, Mark!

I do believe CBT works in many cases. Depression, where it is not physiological, is often caused by low self-esteem, and negative responses to events.

I've never heard of its being used in dementia, though. For one thing, there's a great chance that physiological changes in the brain are the cause of the behavioural difficulties, and I don't see how CBT can address that.

If it's not physiological, then I suppose it depends on the stage of dementia. Beyong a certain stage, which will vary according to the individual, it would be difficult to change thought-patterns and responses.

Sorry sounds a bit negative. But I know nothing! It's certainly worth a try, and I'll be very interested in your reports.

 

[gigi]

Hello Robert!

I had a course of CBT about 18 months ago to help me to deal with reactive depression...

It worked..but it was hard work and required a lot of input on a daily basis from me. I still use the techniques I learnt then...but it does take an awful lot of willpower and strength of mind to put it into daily practise and keep it there!

I've never heard of it being used in dementia...and it's interesting that this idea is being explored.

Maybe you are a unique experiment in this...but unless you give it a try you'll never know..(and neither will we..)

Thanks for posting this..looking forward to hearing how you get on...

Love gigi xx

 

[Tender Face]

Dear Robert ... cognitive therapy (behavioral or otherwise) for the cognitively impaired?? Is that an oxymoron ... or a new groundbreaker?

From personal experience - and in my work - I know 'therapy' can be a very painful process and needs humungous on-going support outside the 'sessions' ... without some inner resilience from the person undertaking the therapy and their support network - it can actually cause more harm than good especially in the short-term .... but the long-term benefits can be well worth it, of course.

Of course, we all want to do our best - but that includes looking after yourself too ... you sound like you have a very knowledgeable and forward thinking Neuropsychologist .... I would be asking how this might impact you and what support you might have for yourself in supporting Mark through the process ....... It is one thing to feel like a pioneer ... another to be left floundering like a reluctant - but 'must try anything' - guinea pig who will be picking up the pieces through the dark days .....

Just my gut feel - but you need to consider your needs and reserves too ... and question the support which might be offered to you ...

Love, Karen, x

 

[robertjohnmills]

Thank you all and here is the first report

Hi Grannie G, Skye, Gigi and Karen
Thanks for all your comments, I was most grateful to read your thoughts. Well here is my first report on how we have got on:
Mark has 3 areas to approach and work on. It is participative therapy in so far the Carer and I do all the work and Mark is supposed to respond through positive reinforcement to good behaviour and ignoring incorrect behaviours!
Week 1 Those we chose are:
1.Speech - Taking Turns: Shown marked improvement
2.Speech - Repetition: No improvement but no worse
3.Hygeine - Bathing: No improvement but no worse
Psychologist said it may get worse before he gets better, but so far we haven't seen that. However he may be lulling us into a false sense of security! Overall pleased enough to go on with it

 

[Skye]

Glad to read it's going well so far, Robert.

I await the next instalment with interest.

 

[Lynne]

Interesting, Robert.

"Speech, Repetition" I will be very surprised if any change can be affected in this regard, since surely it is a factor of the short-term memory loss aspect of dementia? Mark can't remember if he has just asked the time (or can't remember the reply) so that is why he asks again, and again ... Naturally I shall be happy to be proven wrong, not least because it lessens the pressure on you. Constant/frequent repetition can be soooooo difficult to live with.

"Speech, Taking Turns" Yes, I can see this would be helpful. I found that I was the one who had to learn to wait longer for my Mum's thought processes to catch up & formulate what she wanted to say. I used to make the mistake of jumping in & trying to finish her sentences for her (which must have been bloody annoying for her!)

Best wishes to you both.

 

[Margarita]

I also have had CBT

But the main point in havening CBT is to recognize those behavior Cognitively , that is making you feel that way , so you make a plan in how to change those negative behaviors

So it does make me wonder how someone with a Dementia is meant to recognize what they doing, when they can't help doing it in the first place.

Sounds a bit cruel really, asking someone with a Dementia to change there behaviors now they have a dementia when they may not be able to retain the information to recognize cognitive what they are doing is still going to make them feel negative.


I can imagine how hurtful it is for my mother if I said
“Mum you told me that 10 times, can you please stop asking me that question, she feels hurt, negative towards herself
Then the next moment she still ask me the same question .

Your find its a Fact that it not a past memory of an advent that you remember most , but the Feeling of the memory it left you with . So my mother going to remember most in the future the feeling of getting something wrong that made her feel hurt negative , then the memory of me telling her that. when all memory is gone all that left is feeling , if past memory are only negative seem a lot of frustration is going to happen . Not saying that happening ,with your partner just making an example .


sounds like it end up making the the carer feel better , rather then your partner, as it may make it more manageable for the carer to handle those symptoms .

1.Speech - Taking Turns: Shown marked improvement
2.Speech - Repetition: No improvement but no worse
3.Hygeine - Bathing: No improvement but no worse

How dose your partner feel about doing the CBT?

Psychologist said it may get worse before he gets better, but so far we haven't seen that. However he may be lulling us into a false sense of security!

Dementia symptoms only gets worse , so I do not get the Psychologist point when he says . Psychologist said it may get worse before he gets better

so I think your right when you say false sense of security

I wish you both all the best . Hope you keep us updated in how it work out .

 

[gigi]

Hello Robert!

Thanks for the update!

Overall pleased enough to go on with it

That's encouraging...I hope things continue in this positive vein for you both.

Love gigi xx

 

[Grannie G]

Hello Robert

I nearly missed your update.

It is participative therapy in so far the Carer and I do all the work and Mark is supposed to respond through positive reinforcement to good behaviour and ignoring incorrect behaviours!

This is the basis of working with children with challenging behaviour. It does not need a memory, it only needs a reaction. In this respect I can see it might work.

The difference is the carer of someone with dementia has to do all the work, as the one being cared for, although receiving benefit from the experience, will be unable to learn from the experience.

 

[Margarita]

This is the basis of working with children with challenging behaviour. It does not need a memory, it only needs a reaction. In this respect I can see it might work.

That interesting to know

As then it must depend on what stage the person is in to have no memory at all . It does not read like robertjohnmills partner is at that stage yet .

Then People with dementia who do have memory, until they reach the stage to they have no memory at all, should not be treated like a child . As I would of thought, in not treating them like a child, would be positive for there dignity, self respect, self esteem, self worth .


I also hope also it continue to be positive .

 

[Grannie G]

Dear Maggie

It is my belief all children should be treated with regard to developing their

dignity, self respect, self esteem, self worth .

So what is good enough for children is good enough for adults.

 

[Margarita]

Yes , but my point is that an adult with a dementia who does have that already over the years s/he has grown up into an adult , would feel it is demoralize all there dignity, self respect, self esteem, self worth .. If they where treated like a child, to control a challenging behavior due to a symptom of a dementia.

Just my option on it, as we all think different.

 

[robertjohnmills]

More on Mark and CBT

Hi there girls
Yes you are right Grannie, it is just like modifying behaviour in children with challenging behaviour. But Margarita; the Psychologist was quick to point out, that I should not patronise Mark or treat with any less respect, because despite the dementia damage to hia frontal lobes he is quite aware of his adulthood and his perspective / insight will often surprise me.
I like to think that what we are doing here, is just a slightly more formalised version of the way we all behave and modify our behaviours according to such basic elements of needs for praise and social inclusion. Anyway I know you're all dying to learn how its going so here's the stop press!!
1.Speech - Taking Turns: Still showing marked improvement
2.Speech - Repetition: Some improvement and stops when reminded, which he would never have done before.
3.Hygeine - Bathing: Doesn't like, but not the rows and arguments which would ensue if even the very idea of water was suggested.
Thank you for contributing. We appreciate your thoughts

 

[Margarita]

the Psychologist was quick to point out, that I should not patronise Mark or treat with any less respect, because despite the dementia damage to hia frontal lobes he is quite aware of his adulthood and his perspective / insight will often surprise me.

That does sound very positive for Mark , thank you for taking the time out to explain that .

1.Speech - Taking Turns: Still showing marked improvement
2.Speech - Repetition: Some improvement and stops when reminded, which he would never have done before.
3.Hygeine - Bathing: Doesn't like, but not the rows and arguments which would ensue if even the very idea of water was suggested.

Now that does read like there has been a mark improvement in behavior

 

[Sam Iam]

Hi Robert, I have just completed CBT (reactional depression) and find you posts very interesting. Mark's improvent is really positive and must have lifted you mood to, which inturn will hopefully make life seem a bit easier for you. If it is working it is worth while

Continued success for you both xx

 

[purtycat]

hi everyone

iv just been doing a cbt course which i don't really think its helping me iv got two appointments left i can't take it all in i think thats my problem anyway, has it helped anyone else?

 

[robertjohnmills]

CBT has been a help but not in a way expected

Latest report on Mark and I. The CBT has sadly offered little long term behavioural changes in Mark's case. Sadly, it has made me more realistic and less optimistic about what drives him and what I can expect to bear in terms of his current and future care needs. It has not been without minor success, such as the improvement in his perservering repetition, and he is more patient when asked not to interupt. Anyway sorry to offer a bit of a negative report.
Robert

 

[gigi]

Hello Robert..

Thanks for the update..and for being honest about the CBT..no need to apologise for reporting a negative feedback.

Sadly, it has made me more realistic and less optimistic about what drives him and what I can expect to bear in terms of his current and future care needs.

Although that is a sad statement...there is a positive there because you now know what you are dealing with..and what you may have to face.

Please keep posting...we're here to support you ...

love xx